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During Oprah Winfrey’s “2020 Vision: Your Life in Focus Tour” several weeks ago in Los Angeles, she spoke about wellness and balance. Unfortunately, immediately after mentioning balance in her speech, she lost her footing and tumbled onto the stage, a reminder of how important balance is to our overall health.

The human brain and nervous system are very intricately engineered to help us maintain our balance. There are four main areas in our nervous system that coordinate together and are crucial to having good balance. A defect in any of these four areas can cause balance problems. These areas are the labyrinthine system, the visual pathways, the cerebellum and the peripheral nerves.

The labyrinthine system is located close to the inner ear and is closely aligned with the hearing apparatus. The visual pathways refers to the eyes and the part of our brain that processes images. The cerebellum is a large section of the brain located in the back of the skull, which helps to coordinate our limb movements. The peripheral nerves are located in our arms, hands, feet and legs. These provide stimulation to our muscles for limb movement and they also send sensory signals to the brain related to body position, as well as sensations of pain and temperature.

One example of a defect that cause balance problems is vision impairment. Such an impairment will cause problems in the functioning of the other key brain and nerve areas that govern balance.

It should also be noted that there are other very specific situations associated with poor balance. Someone with low blood pressure, which is often a side effect of prescription medications, can be prone to falls. Diabetes mellitus can cause damage to the peripheral nerves, which can lead to impaired sensation in the feet and legs, and consequently poor balance. Some vitamin deficiencies, such as Vitamin B12 can cause similar nerve damage issues as described with diabetes. Exposure to certain toxins, such as alcohol, can also lead to similar peripheral nerve problems. People who have arthritis in their legs or feet or damage to tendons or ligaments in their legs, are also prone to poor balance.

Balance exercises can help you maintain your balance at any age and can be effective for fall prevention. A good first start to addressing balance problems would be to meet with a physical therapist. They have the skills to analyze a person’s specific risk factors for falls and can prescribe a course of therapy that can be tailored to the individual’s specific weaknesses.

A person with less serious balance concerns can undertake exercises on their own initiative to improve balance. These exercises could include yoga, tai-chi or simply going for frequent walks, to strengthen leg muscles, tendons and ligaments. It’s very important to be as active as one can within the limits of one’s capabilities, because a sedentary existence can weaken all of the body parts that are needed to ensure good balance. As George Bernard Shaw stated: “We don’t stop playing because we grow old; we grow old because we stop playing.”


Dr. Mark Roth writes about internal medicine for the Cleveland Jewish News. He is an internal medicine physician with University Hospitals.

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